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EMDR Training Registration Form
Training dates for Spring 2022 will all be conducted online on Zoom
Part 1: Thursday to Sunday March 3, 4, 5 & 6, 2022 (9:00am-5:00pm CST - lunch 12:30-1:00) Consultation#1: at Part 2 on March 18 Part 2: Friday to Sunday March 18, 19 & 20, 2022 (9:00am-5:00pm CST - lunch 12:30-1:00) Consultation #2: at part 3 on April 7 Part 3: Thursday & Friday April 7 & 8, 2022 (9:00am-4:30pm CST – lunch 12:00-12:30) Consultation #3: Choose either Wednesday May 4 (6:00-8:00pm CST) or Thursday May 5 (2:00-4:00pm CST)) Consultation #4: Choose either Wednesday May 18 (6:00-8:00pm CST) or Friday May 20 (9:00-11:00am CST)
Consultation preferences between training sessions
Please indicate your preference
Consultation #3
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(choose 1 of the following)
Wednesday May 4 6:00-8:00pm CST
Thursday May 5 2:00-4:00pm CST
Consultation #4
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(choose 1 of the following)
Wednesday May 18 6:00-8:00pm CST
Friday May 20 9:00-11:00am CST
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Please indicate special considerations and accommodations:
Confidentiality
Practicum is a major component of training. This may include your engaging in your own processing work, although you have the option to not be in the client role. Please talk to the instructor prior to the beginning of the training should you have any concerns regarding practicum components (e.g. if it is not currently safe for you to engage in processing). For the purpose of training, you are only required to be in the role of clinician during practicum to practice and develop new skills. As in your therapeutic practice, confidentiality is very important throughout this training. You will be working with fellow clinicians during practicum and sharing personal information. This information is to be kept confidential to ensure safety of participants, including yourself.
Check the box below
*
I acknowledge your understanding and agreement to maintain participant confidentiality
In addition, during group consultation you will be sharing client experiences as you begin to use EMDR therapy. Confidentiality is paramount and required on all cases discussed, relative to discussions held and cases reviewed. Signed releases by the participant’s clients are required on all cases discussed in meetings (please ensure this is included on any policy forms that describe confidentiality for your practice). It is the participant’s responsibility to maintain the release in the client’s file. You must be able to practice EMDR therapy following Part 1 of training.
Check the box below
*
I acknowledge your understanding and agreement to maintain client confidentiality
Prerequisites for EMDR Training
Licensed Health Professionals
Medical Doctors licensed in their province or state
Registered Nurses who have a Masters Degree with a specialization in mental health and who are licensed in their province or state
Mental health clinicians who have at minimum of a Master’s Degree in a mental health field (Counseling, Marriage and Family Therapy, Psychology, Psychotherapy, Psychiatry, Social Work) or related mental health discipline and be licensed to practice through a professional organization or regulation body that includes a code of ethics and public protection.
Pre-Licensed Mental Health Professionals
Clinicians who are actively pursuing a mental health license through their provincial, state, or national regulating body while working under a licensed supervisor (e.g., intern, associate).
Pre-Licensed clinicians who have a Master’s Degree in a mental health field and are actively pursuing a full license through their provincial, state, or national regulating body.
Graduate Students
Clinicians who are actively pursuing a mental health license through their provincial, state, or national regulating body while working under a licensed supervisor (e.g., intern, associate).
Pre-Licensed clinicians who have a Master’s Degree in a mental health field and are actively pursuing a full license through their provincial, state, or national regulating body.
Check the box below
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I acknowledge that I meet the above pre-requisites for EMDR Training.
If you are unsure that you meet these pre-requisites, please contact the training provider. All participants are welcome at training, so long as the pre-requisites are met, regardless of an individual’s sexual orientation, gender identity, race, ethnicity, culture, religion, or disability. Participants will be supported throughout training to best help them learn and integrate the material. For further discussion, please contact Dr. Penner Hutton.
Attach to your registration:
A copy of your Master or Doctoral Diploma
A copy of your liability insurance if you are in private practice
A copy of your license as a mental health provider
Payment in the amount of $200 non-refundable deposit to hold your space (which will be deducted from later payments for the early or regular registration fees). e-transfer to drkelly@peaceofmindemdr.ca
o Early registration paid by January 21, 2022 (11:59pm) $2200+$110GST = $2310 (paid in full by January 21, 2022) o Regular registration January 21-February 25, 2022 => $2400+$120GST = $2520 (paid in full by February 25, 2022)
Note: The earlier you register, the earlier you will receive the course materials and can engage in pre-learning reading
Diploma, Insurance and License File Upload
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Accepted file types: pdf, png, jpg.